Computerization of workflows, guidelines and care pathways: a review of implementation challenges for process-oriented health information systems

There is a need to integrate the various theoretical frameworks and formalisms for modeling clinical guidelines, workflows, and pathways, in order to move beyond providing support for individual clinical decisions and toward the provision of process-oriented, patient-centered, health information systems (HIS). In this review, we analyze the challenges in developing process-oriented HIS that formally model guidelines, workflows, and care pathways. A qualitative meta-synthesis was performed on studies published in English between 1995 and 2010 that addressed the modeling process and reported the exposition of a new methodology, model, system implementation, or system architecture. Thematic analysis, principal component analysis (PCA) and data visualisation techniques were used to identify and cluster the underlying implementation ‘challenge’ themes. One hundred and eight relevant studies were selected for review. Twenty-five underlying ‘challenge’ themes were identified. These were clustered into 10 distinct groups, from which a conceptual model of the implementation process was developed. We found that the development of systems supporting individual clinical decisions is evolving toward the implementation of adaptable care pathways on the semantic web, incorporating formal, clinical, and organizational ontologies, and the use of workflow management systems. These architectures now need to be implemented and evaluated on a wider scale within clinical settings

Employment Action Plan : 2002

"The UK Employment Action Plan 2002 was produced after extensive consultation and agreement across Government Departments and agencies responsible for the employment, economic and social fields. Beyond Government, the production of the Plan involves a wide range of stakeholders. This year the main external partners were the CBI, TUC, CEEP UK and the Regional Development Agencies (the main strategic coordinators of local activity in England). The Devolved Administrations of Northern Ireland, Scotland and Wales have made their own separate contributions" -- page 3

Genetic embedded matching approach to ground states in continuous-spin systems

Due to an extremely rugged structure of the free energy landscape, the determination of spin-glass ground states is among the hardest known optimization problems, found to be NP-hard in the most general case. Owing to the specific structure of local (free) energy minima, general-purpose optimization strategies perform relatively poorly on these problems, and a number of specially tailored optimization techniques have been developed in particular for the Ising spin glass and similar discrete systems. Here, an efficient optimization heuristic for the much less discussed case of continuous spins is introduced, based on the combination of an embedding of Ising spins into the continuous rotators and an appropriate variant of a genetic algorithm. Statistical techniques for insuring high reliability in finding (numerically) exact ground states are discussed, and the method is benchmarked against the simulated annealing approach.Comment: 17 pages, 12 figures, 1 tabl

Automatically Restructuring Practice Guidelines using the GEM DTD

This paper describes a system capable of semi-automatically filling an XML template from free texts in the clinical domain (practice guidelines). The XML template includes semantic information not explicitly encoded in the text (pairs of conditions and actions/recommendations). Therefore, there is a need to compute the exact scope of conditions over text sequences expressing the required actions. We present a system developed for this task. We show that it yields good performance when applied to the analysis of French practice guidelines

Leveraging workflow control patterns in the domain of clinical practice guidelines

Background: Clinical practice guidelines (CPGs) include recommendations describing appropriate care for the management of patients with a specific clinical condition. A number of representation languages have been developed to support executable CPGs, with associated authoring/editing tools. Even with tool assistance, authoring of CPG models is a labor-intensive task. We aim at facilitating the early stages of CPG modeling task. In this context, we propose to support the authoring of CPG models based on a set of suitable procedural patterns described in an implementation-independent notation that can be then semi-automatically transformed into one of the alternative executable CPG languages. Methods: We have started with the workflow control patterns which have been identified in the fields of workflow systems and business process management. We have analyzed the suitability of these patterns by means of a qualitative analysis of CPG texts. Following our analysis we have implemented a selection of workflow patterns in the Asbru and PROforma CPG languages. As implementation-independent notation for the description of patterns we have chosen BPMN 2.0. Finally, we have developed XSLT transformations to convert the BPMN 2.0 version of the patterns into the Asbru and PROforma languages. Results: We showed that although a significant number of workflow control patterns are suitable to describe CPG procedural knowledge, not all of them are applicable in the context of CPGs due to their focus on single-patient care. Moreover, CPGs may require additional patterns not included in the set of workflow control patterns. We also showed that nearly all the CPG-suitable patterns can be conveniently implemented in the Asbru and PROforma languages. Finally, we demonstrated that individual patterns can be semi-automatically transformed from a process specification in BPMN 2.0 to executable implementations in these languages. Conclusions: We propose a pattern and transformation-based approach for the development of CPG models. Such an approach can form the basis of a valid framework for the authoring of CPG models. The identification of adequate patterns and the implementation of transformations to convert patterns from a process specification into different executable implementations are the first necessary steps for our approach.This research has been supported by: 1) Austrian Science Fund (FWF) through project TRP71-N23. 2) Spanish Ministry of Education through grant PR2010-0279, and by Universitat Jaume I through project P11B2009-38

Preparing HPC Applications for the Exascale Era: A Decoupling Strategy

Production-quality parallel applications are often a mixture of diverse operations, such as computation- and communication-intensive, regular and irregular, tightly coupled and loosely linked operations. In conventional construction of parallel applications, each process performs all the operations, which might result inefficient and seriously limit scalability, especially at large scale. We propose a decoupling strategy to improve the scalability of applications running on large-scale systems. Our strategy separates application operations onto groups of processes and enables a dataflow processing paradigm among the groups. This mechanism is effective in reducing the impact of load imbalance and increases the parallel efficiency by pipelining multiple operations. We provide a proof-of-concept implementation using MPI, the de-facto programming system on current supercomputers. We demonstrate the effectiveness of this strategy by decoupling the reduce, particle communication, halo exchange and I/O operations in a set of scientific and data-analytics applications. A performance evaluation on 8,192 processes of a Cray XC40 supercomputer shows that the proposed approach can achieve up to 4x performance improvement.Comment: The 46th International Conference on Parallel Processing (ICPP-2017

Effectiveness and cost effectiveness of pharmacist input at the ward level: a systematic review and meta-analysis

Background Pharmacists play important role in ensuring timely care delivery at the ward level. The optimal level of pharmacist input, however, is not clearly defined. Objective To systematically review the evidence that assessed the outcomes of ward pharmacist input for people admitted with acute or emergent illness. Methods The protocol and search strategies were developed with input from clinicians. Medline, EMBASE, Centre for Reviews and Dissemination, The Cochrane Library, NHS Economic Evaluations, Health Technology Assessment and Health Economic Evaluations databases were searched. Inclusion criteria specified the population as adults and young people (age >16 years) who are admitted to hospital with suspected or confirmed acute or emergent illness. Only randomised controlled trials (RCTs) published in English were eligible for inclusion in the effectiveness review. Economic studies were limited to full economic evaluations and comparative cost analysis. Included studies were quality-assessed. Data were extracted, summarised. and meta-analysed, where appropriate. Results Eighteen RCTs and 7 economic studies were included. The RCTs were from USA (n=3), Sweden (n=2), Belgium (n=2), China (n=2), Australia (n=2), Denmark (n=2), Northern Ireland, Norway, Canada, UK and Netherlands. The economic studies were from UK (n=2), Sweden (n=2), Belgium and Netherlands. The results showed that regular pharmacist input was most cost effective. It reduced length-of-stay (mean= -1.74 days [95% CI: -2.76, -0.72], and increased patient and/or carer satisfaction (Relative Risk (RR) =1.49 [1.09, 2.03] at discharge). At £20,000 per quality-adjusted life-year (QALY)-gained cost-effectiveness threshold, it was either cost-saving or cost-effective (Incremental Cost Effectiveness Ratio (ICER) =£632/ QALY-gained). No evidence was found for 7-day pharmacist presence. Conclusions Pharmacist inclusion in the ward multidisciplinary team improves patient safety and satisfaction and is cost-effective when regularly provided throughout the ward stay. Research is needed to determine whether the provision of 7-day service is cost-effective.Peer reviewe

Analyzing the Scope of Conditions in Texts: A Discourse-Based Approach

International audienceThis paper focuses on the task that consists in automatically structuring free texts according to semantic principles, hence requiring a discourse analysis. We show that the task can be rephrased as a machine learning task in which the algorithm is supposed to take an optimal decision from the range of complex interacting constraints. The approach is implemented and evaluated taking the example of Health Practices Guidelines, medium-size documents intended to describe common practices that should be followed by physicians. Our approach outperforms previous approaches limited to sentence boundaries or requiring a lot of manual work

Benchmarking Distributed Stream Data Processing Systems

The need for scalable and efficient stream analysis has led to the development of many open-source streaming data processing systems (SDPSs) with highly diverging capabilities and performance characteristics. While first initiatives try to compare the systems for simple workloads, there is a clear gap of detailed analyses of the systems' performance characteristics. In this paper, we propose a framework for benchmarking distributed stream processing engines. We use our suite to evaluate the performance of three widely used SDPSs in detail, namely Apache Storm, Apache Spark, and Apache Flink. Our evaluation focuses in particular on measuring the throughput and latency of windowed operations, which are the basic type of operations in stream analytics. For this benchmark, we design workloads based on real-life, industrial use-cases inspired by the online gaming industry. The contribution of our work is threefold. First, we give a definition of latency and throughput for stateful operators. Second, we carefully separate the system under test and driver, in order to correctly represent the open world model of typical stream processing deployments and can, therefore, measure system performance under realistic conditions. Third, we build the first benchmarking framework to define and test the sustainable performance of streaming systems. Our detailed evaluation highlights the individual characteristics and use-cases of each system.Comment: Published at ICDE 201